RIGHT FRAYS OVER EMERGING FISCAL DEAL — This couldn’t be what the tea party had in mind: Republican efforts to smash Obamacare during debt ceiling talks are looking more like nibbles on the margins. Pro’s David Nather reports that many on the right are incensed that the GOP appears ready to trade in its leverage for a couple mini changes to the massive health law: “The whole point of urging Republicans to use the continuing resolution and debt ceiling bills as leverage, in their view, was to force a real shutdown of Obamacare, not just settle for one or two minor concessions.” A look at the divergent opinions emerging on the right: http://politi.co/19DroHj

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Welcome to Tuesday PULSE, five years to the day that the Dow dropped 733 points on one of the worst days in stock market history. Nothing like the anniversary of an economic collapse to punctuate the stakes of the debt ceiling debate: http://nyti.ms/2SNeAG

“Like a true nature’s child, we were born, born to be PULSE”

OBAMACARE REINSURANCE FEE TARGETED IN SENATE DEBT TALKS – The tentative deal in the Senate to lift the debt ceiling would delay Obamacare’s reinsurance fee for one year. The reinsurance tax was supposed to be levied against group insurance plans to help spread risk for insurers who take on the sickest patients next year. The fee would have amounted to $63 per person covered per year. Under the proposal, the fee would not be collected in 2014 but the reimbursement fund would pay insurers anyway, sources tell POLITICO, using an advance from the Treasury in the first year of the three-year program. It would be paid back when fees are collected in a fourth year that is added on.

--Delaying the fee was a priority for labor unions, who were rebuffed last month when they pushed the White House to allow people in union plans to get Obamacare's tax subsidies. Unions are slated to pay the reinsurance fees without getting any benefit from them. One expert said the change is proof the Obama administration long had reservations about the program’s structure. “HHS agreed with their objections but essentially said their hands were tied by the ACA,” according to Billy Wynne at Thorn Run Partners & Healthcare Lighthouse. Insurers would likely rebel if the program was completely eliminated, though. ‘The ACA’s reinsurance program is essential to help stabilize the individual insurance market and mitigate some cost increases for consumers as the new insurance reforms take effect,” said AHIP spokesman Robert Zirkelbach.

BROKERS WAITING FOR ENROLLMENT FIXES — Big-name online health insurance brokers trumpeted their partnerships with the Obama administration to sell new exchange insurance options, but the music stopped on Oct. 1. Brokers like GoHealth, eHealthInsurance and GetInsured are biding their time while major malfunctions to the federal enrollment system are worked out. Per Pro’s Jason Millman: “The brokers say CMS didn’t act fast enough to let them integrate their websites with the IT systems supporting the federal insurance marketplaces. They hope to get everything linked up with the feds in the coming weeks … The Web brokers say system integration is the last step they need to take before connecting to the federal-run portal known as the data hub. http://politico.pro/1bSbuOH

--Interestingly, California, which is running its own health insurance exchange, has opted against partnering with online brokers, the LA Times reports, calling the split with the federal government proof that Obamacare will look different in every state: http://lat.ms/1aGzxLh

COUNTDOWN TO JAN. 1 OBAMACARE COVERAGE – 78 days.

DEVICE TAX HATERS BRINGING IN INDUSTRY CASH — Lawmakers making the case for a medical device tax repeal might win even if they lose. Reps. Ron Kind (D-Wis.), Erik Paulsen (R-Minn.) and Jim Matheson (D-Utah) are also among the top 12 House beneficiaries of medical device tax industry cash. Pro’s Rachael Bade reports lawmakers advocating for the tax repeal have tended to haul in twice as much from the industry than their colleagues. “Paulsen has been another central player in the repeal deal idea, talking to colleagues at votes, Speaker John Boehner and even touching base with fellow Minnesotan Sen. Amy Klobuchar (D) on the issue ‘almost daily,’ he said. Minnesota also happens to be home to one of the biggest medical device companies in the U.S. — Medtronic.” http://politico.pro/19JM8ev

STUDY: HOSPITAL EXECS PAY NOT LINKED TO PATIENT OUTCOMES — A new study in JAMA Internal Medicine suggests nonprofit hospital CEOs’ salaries have no correlation to patient outcomes, the Associated Press reports. The study found that patients’ 30-day outcomes for heart attacks, heart failure and pneumonia figured little into the pay of top officials. An editorial accompanying the study, however, disputes the findings, the AP reports. The average CEO salary? $600,000 a year.

CLINTON BACKS UP MCAULIFFE ON OBAMACARE — Former President Bill Clinton waded into the Virginia governor’s race Monday with an email talking up his “close friend” Terry McAuliffe for, among other things, standing up for Obamacare. In an email circulated by national Democrats, Clinton noted that Attorney General Ken Cuccinelli, McAuliffe’s Republican opponent, was among the first to file suit to overturn Obamacare. “They want to repeal the Affordable Care Act. We want it to work,” Clinton wrote.

MEDICAID ENROLLMENT SOARS IN WASHINGTON — Washington State’s Obamacare exchange issued new stats Monday that point to surging enrollment in the state’s Medicaid program. Nearly 25,000 people enrolled in new coverage through the state’s portal, Washington Healthplanfinder, since Oct. 1, and all but 3,000 enrolled in Medicaid. About 37,000 people who have applied for private coverage through the exchange are still awaiting determinations. Washington, which opted to run its own exchange, has been among the only states able to confirm a significant number of enrollees. “We’re pleased to see that Medicaid enrollments are continuing their strong trend,” said Dorothy Teeter, director of the state Health Care Authority. “The bulk of those enrollments are the newly eligible — with children also enrolling at a good pace.”

NEW HAMPSHIRE PANEL READIES REPORT ON MEDICAID EXPANSION — A New Hampshire panel of lawmakers is preparing to recommend today that the state expand its Medicaid program under Obamacare — with a few stipulations. According to the Associated Press, the panel wants to require that people with employer-based health care coverage stay on their plan rather than join Medicaid and they want to offer the Medicaid-eligible the option to buy private insurance on the state’s exchange. The vote caps months of review. Gov. Maggie Hassan, a Democrat, has long supported Medicaid expansion, but the state’s Republican Senate has blocked her efforts so far.

WHAT WE’RE READING

- The Wall Street Journal reports that nearly 100,000 Americans are close to enrolling in insurance through state-based exchanges — and about 38,000 have already done so: http://on.wsj.com/GVYrOg

- On the WSJ op-ed page, actor Rick Moranis satires the impact of the health law — and HealthCare.gov: http://on.wsj.com/19JsFi0

- It’s open season on HealthCare.gov — the Christian Science Monitor reports that cybersecurity experts fear the Obamacare enrollment could be vulnerable to hackers and thieves: http://bit.ly/1aGtRRq

- Former New Hampshire Sen. John Sununu, a Republican, estimates that the Obama administration has 60 days to turn around HealthCare.gov … or else. His Boston Globe op-ed: http://b.globe.com/1clkrgq

- No one’s signed up for Alaska’s health insurance exchange and Sen. Lisa Murkowski is pushing for weekly enrollment updates, the Associated Press reports: http://bit.ly/1gG4RP5

- David Quammen rights in The New York Times about the likelihood of a the next pandemic (hint: it’ll probably originate from livestock): http://nyti.ms/GYzu5g

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Authors:

About The Author

Kyle Cheney is a reporter for POLITICO’s Campaign Pro.

Cheney came to POLITICO in June 2012 to cover health care and spent two years covering the implementation of the Affordable Care Act and its political implications – from the Supreme Court decision upholding the law to the rollout of HealthCare.gov and the coverage gains that ensued. He came to POLITICO after five years reporting on Massachusetts government and politics for the State House News Service, an independent wire service. Coverage, which appeared daily in The Boston Globe, Boston Herald and others, included the implementation of a near-universal health care law; the indictment, trial and conviction of the state’s third felonious House speaker in a row; the rise and reelection of Gov. Deval Patrick; and all matters of public policy.

Cheney, a New York native and unabashed Yankees fan, graduated from Boston University in 2007 with a journalism degree after a semester as editor of BU’s student paper, The Daily Free Press.